MEDICARE: LLOYD MUNSON OT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	2939	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679775860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LLOYD MUNSON OT

Provider Business Mailing Address
First Line	:	3301 W FOREST HOME AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53215-2843
Country	:	US
Telephone Number	:	414-858-1740
Fax Number	:

Provider Business Practice Location Address
First Line	:	9120 W LOOMIS RD
Second Line	:
City	:	FRANKLIN
State	:	WI
Zip	:	53132-9083
Country	:	US
Telephone Number	:	414-858-1740
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2007
Last Update Date	:	12/13/2021

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